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Journal of Neuro-Oncology

, Volume 108, Issue 1, pp 187–193 | Cite as

Pilocytic astrocytoma survival in adults: analysis of the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute

  • Derek R. Johnson
  • Paul D. Brown
  • Evanthia Galanis
  • Julie E. Hammack
Clinical Study

Abstract

Pilocytic astrocytoma is a WHO grade 1 brain tumor common in children. Relatively little is known about the behavior of pilocytic astrocytomas in adult patients, largely due to the rarity of pilocytic astrocytoma in this population. Some data suggest that adults share the excellent prognosis seen in children, while other reports suggest more aggressive tumor behavior in adult patients. Patients diagnosed with pilocytic astrocytoma between 1973 and 2008 were identified in the National Cancer Institute Surveillance, Epidemiology, and End Results Program database. Age-group specific survival was analyzed with overall, expected, and cancer-specific survival rates. Further survival analyses were performed with the Kaplan–Meier method and Cox Proportional Hazards models. 3,066 patients with pilocytic astrocytoma were identified, including 865 patients aged 20 years and older. Survival rates declined significantly with age, from 96.5% 60-month survival in patients 5–19 years (95% CI 95.3–97.4) to 52.9% 60-month survival in adult patients 60+ years of age (95% CI 38.4–65.5), with a corresponding decrease in relative and cancer-specific survival rates. Gross total resection was a positive prognostic indicator in adults, while patients receiving radiation had shorter survival regardless of extent of resection. Pilocytic astrocytoma is associated with higher mortality in adult patients than in children and teens, and survival decreases with increasing age in adults. The morbidity of pilocytic astrocytoma in adults provides rationale for future trials of adjuvant treatment in high-risk patients.

Keywords

Pilocytic astrocytoma Adult Mortality SEER program Survival 

Notes

Acknowledgments

None.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Central Brain Tumor Registry of the United States (CBTRUS). CBTRUS Statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2004–2007. http://www.cbtrus.org/2011-NPCR-SEER/WEB-0407-Report-3-3-2011.pdf. Accessed September 1, 2011
  2. 2.
    Dirven CM, Mooij JJ, Molenaar WM (1997) Cerebellar pilocytic astrocytoma: a treatment protocol based upon analysis of 73 cases and a review of the literature. Childs Nerv Syst 13:17–23PubMedCrossRefGoogle Scholar
  3. 3.
    Bell D, Chitnavis BP, Al-Sarraj S, Connor S, Sharr MM, Gullan RW (2004) Pilocytic astrocytoma of the adult–clinical features, radiological features and management. Br J Neurosurg 18:613–616PubMedCrossRefGoogle Scholar
  4. 4.
    Ellis JA, Waziri A, Balmaceda C, Canoll P, Bruce JN, Sisti MB (2009) Rapid recurrence and malignant transformation of pilocytic astrocytoma in adult patients. J Neurooncol 95:377–382PubMedCrossRefGoogle Scholar
  5. 5.
    Favre J, Deruaz JP, de Tribolet N (1993) Pilocytic cerebellar astrocytoma in adults: case report. Surg Neurol 39:360–364PubMedCrossRefGoogle Scholar
  6. 6.
    Stuer C, Vilz B, Majores M, Becker A, Schramm J, Simon M (2007) Frequent recurrence and progression in pilocytic astrocytoma in adults. Cancer 110:2799–2808PubMedCrossRefGoogle Scholar
  7. 7.
    Brown PD, Buckner JC, O’Fallon JR, Iturria NL, Brown CA, O’Neill BP, Scheithauer BW, Dinapoli RP, Arusell RM, Abrams RA, Curran WJ, Shaw EG (2004) Adult patients with supratentorial pilocytic astrocytomas: a prospective multicenter clinical trial. Int J Radiat Oncol Biol Phys 58:1153–1160PubMedCrossRefGoogle Scholar
  8. 8.
    Garcia DM, Fulling KH (1985) Juvenile pilocytic astrocytoma of the cerebrum in adults. A distinctive neoplasm with favorable prognosis. J Neurosurg 63:382–386PubMedCrossRefGoogle Scholar
  9. 9.
    Kano H, Kondziolka D, Niranjan A, Flickinger JC, Lunsford LD (2009) Stereotactic radiosurgery for pilocytic astrocytomas part 1: outcomes in adult patients. J Neurooncol 95:211–218PubMedCrossRefGoogle Scholar
  10. 10.
    Claus EB, Black PM (2006) Survival rates and patterns of care for patients diagnosed with supratentorial low-grade gliomas: data from the SEER program, 1973–2001. Cancer 106:1358–1363PubMedCrossRefGoogle Scholar
  11. 11.
    Iwamoto FM, Cooper AR, Reiner AS, Nayak L, Abrey LE (2009) Glioblastoma in the elderly: the memorial Sloan-Kettering cancer center experience (1997–2007). Cancer 115:3758–3766PubMedCrossRefGoogle Scholar
  12. 12.
    Smoll NR (2011) Relative survival of childhood and adult medulloblastomas and primitive neuroectodermal tumors (PNETs). Cancer. doi: 10.1002/cncr.26387
  13. 13.
    National Cancer Institute (2011) About the surveillance, epidemiology, and end results (SEER) program. http://www.seer.cancer.gov/about/. Accessed May 10, 2011
  14. 14.
    Surveillance, epidemiology, and end results (SEER) program (www.seer.cancer.gov) SEER*Stat database: incidence: SEER 17 Regs research data + hurricane katrina impacted Louisiana cases, Nov 2010 Sub (1973–2008 varying): Linked To County Attributes - Total U.S., 1969–2009 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2011, based on the November 2010
  15. 15.
    Howlader N, Ries LA, Mariotto AB, Reichman ME, Ruhl J, Cronin KA (2010) Improved estimates of cancer-specific survival rates from population-based data. J Natl Cancer Inst 102:1584–1598PubMedCrossRefGoogle Scholar
  16. 16.
    Surveillance research program N: SEER Cause-specific death classification: SEER Recodes. National Cancer Institute, BethesdaGoogle Scholar
  17. 17.
    Surveillance research program, National Cancer Institute (2011) SEER*Stat software (seer.cancer.gov/seerstat) version 7.0.5Google Scholar
  18. 18.
    Ederer F, Axtell LM, Cutler SJ (1961) The relative survival rate: a statistical methodology. Natl Cancer Inst Monogr 6:101–121PubMedGoogle Scholar
  19. 19.
    Ederer F, Heise H (1959) Instructions to IBM 650 programmers in processing survival computations. Methodological Note 10, End results section. National Cancer Institute, BethesdaGoogle Scholar
  20. 20.
    Ishkanian A, Laperriere NJ, Xu W, Millar BA, Payne D, Mason W, Sahgal A (2011) Upfront observation versus radiation for adult pilocytic astrocytoma. Cancer 117:4070–4079PubMedCrossRefGoogle Scholar
  21. 21.
    Kayama T, Tominaga T, Yoshimoto T (1996) Management of pilocytic astrocytoma. Neurosurg Rev 19:217–220PubMedCrossRefGoogle Scholar
  22. 22.
    R Development Core Team (2011). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. ISBN 3-900051-07-0, URL http://www.R-project.org/
  23. 23.
    Forsyth PA, Shaw EG, Scheithauer BW, O’Fallon JR, Layton DD Jr, Katzmann JA (1993) Supratentorial pilocytic astrocytomas. A clinicopathologic, prognostic, and flow cytometric study of 51 patients. Cancer 72:1335–1342PubMedCrossRefGoogle Scholar
  24. 24.
    Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA, Marosi C, Bogdahn U, Curschmann J, Janzer RC, Ludwin SK, Gorlia T, Allgeier A, Lacombe D, Cairncross JG, Eisenhauer E, Mirimanoff RO (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996PubMedCrossRefGoogle Scholar
  25. 25.
    Rodriguez FJ, Scheithauer BW, Burger PC, Jenkins S, Giannini C (2010) Anaplasia in pilocytic astrocytoma predicts aggressive behavior. Am J Surg Pathol 34:147–160PubMedCrossRefGoogle Scholar
  26. 26.
    Rodriguez EF, Scheithauer BW, Giannini C, Rynearson A, Cen L, Hoesley B, Gilmer-Flynn H, Sarkaria JN, Jenkins S, Long J, Rodriguez FJ (2011) PI3K/AKT pathway alterations are associated with clinically aggressive and histologically anaplastic subsets of pilocytic astrocytoma. Acta Neuropathol 121:407–420PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2012

Authors and Affiliations

  • Derek R. Johnson
    • 1
  • Paul D. Brown
    • 2
    • 3
  • Evanthia Galanis
    • 4
  • Julie E. Hammack
    • 1
  1. 1.Department of NeurologyMayo ClinicRochesterUSA
  2. 2.Department of Radiation OncologyMayo ClinicRochesterUSA
  3. 3.Department of Radiation OncologyM.D. Anderson Cancer CenterHoustonUSA
  4. 4.Department of OncologyMayo ClinicRochesterUSA

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